APPLICATION FOR EMPLOYMENT
THIS APPLICATION MUST BE SIGNED AND DATED ON PAGE 3 BY APPLICANT AND LIBRARY STAFF MEMBERIN ORDER TO BE A VALID APPLICATIONYOUR OBJECTIVE
Job Position Code: FAC 2017-1227 Today’s Date:Date available for work / Employment interests
Full-time Part-time / Will you work evenings/weekends if necessary?
Yes No
PERSONAL
Name: last first middleAddress: number street city state zip code
Telephone number
( ) / E-mail / Are you 18 years of age or older?
Yes No
EDUCATION
Highest elementary or high school grade completed (circle)1 2 3 4 5 6 7 8 9 10 11 12 / Did you graduate or receive a GED?
School name / Dates attended / Major Subjects / Graduated / Date degree
granted or
expected / Diploma
or
Degree
From / To
Mo. Yr. / Mo. Yr.
Vocational/technical school / Yes
No
College / Yes
No
Graduate school / Yes
No
Other special schooling
MILITARY
Military Service Yes No / U.S. Military Branch / Highest rank achieved / Date entered / Date of separation or discharge
Civilian related experience and training
REFERENCES (List three work references who are qualified to describe your work abilities)
Name /Address
/Telephone number
/Company
1)2)
3)
AN EQUAL OPPORTUNITY EMPLOYER –
Applicant is not required to give any information on this form that is prohibited by federal, state, or local law
EMPLOYMENT HISTORY (Also list any period of unemployment that exceeds 90 days)
1) Company name of last or current employer / Title and primary job tasks
Address Phone number
Date hired / Salary Per
Date left / Salary Per
Supervisor’s name
May we contact your supervisor for a reference before a job
offer is made? Yes No / Reason for leaving
2) Company name of previous employer / Title and primary job tasks
Address Phone number
Date hired / Salary Per
Date left / Salary Per
Supervisor’s name / Reason for leaving
3) Company name of previous employer / Title and primary job tasks
Address Phone number
Date hired / Salary Per
Date left / Salary Per
Supervisor’s name / Reason for leaving
OFFICE EQUIPMENT SKILLS (Check skills and equipment operated)
Personal Computer Macintosh
Internet / Windows 2000
Microsoft Word
Microsoft Excel / Microsoft Access
Microsoft Outlook
Page layout software / Graphic Design
Other______
FOREIGN LANGUAGES
FLUENT / GOOD / FAIRSPEAK
READ
WRITE
OTHER INFORMATION
Have you previously applied for a job with the library?
Yes No / Have you previously been employed by the library?
Yes No
Have you been convicted under any criminal law as an adult?
Yes No
Note: a criminal conviction does not automatically disqualify you. / If yes, explain:
Have you been convicted under any misdemeanor law as an adult?
Yes No
Note: a misdemeanor conviction does not automatically disqualify you.
Are you a U.S. citizen? Yes No
If you are not a U.S. citizen, does your visa or immigration status permit youto become lawfully employed? Yes No
Please use this space for any additional remarks you may have regarding your qualifications.
Applicant: READ BEFORE SIGNING AND SUBMITTING THIS APPLICATION
Proof of citizenship or immigration status will be required upon employment.
To ensure that employees and volunteers of Fayetteville Public Library are well-qualified and to further ensure that Fayetteville Public Library maintains a safe and productive work environment free of any form of violence, harassment or misconduct—it is the policy of Fayetteville Public Library to screen applicants, whether for employment or volunteer work, and to verify applicant references, credentials, or both. I agree and understand that Fayetteville Public Library may investigate my background and employment history to ascertain any
and all information pertaining to my record, whether same is of record or not. I release employers and persons named herein from all liability for any damages on account of their furnishing such information.
I agree to furnish any additional information and/or submit to oral, written or physical examination as may be required to complete the employment file.
It is agreed and understood that this application for employment does not obligate the library to employ me. Further, I understand and agree that, if employed, my employment is at will only and for no term of definite duration. I also understand and agree that either I or the Fayetteville Public Library may terminate the employment relationship at any time.
This certifies that this application was completed by me, the undersigned, and that all entries and information on it are true and complete to the best of my knowledge. I understand that misrepresentation or omission of facts called for in this application, in any supplement thereto, or in any library records, will be sufficient grounds for not employing me, or will be cause for immediate dismissal without notice at any time during my employment.
We appreciate your interest in our library as a place of employment. Your qualifications will be given careful consideration. It is our continuing policy to provide each individual equal opportunity in all aspects of employment regardless of sex, color, age, religion, national origin or an otherwise qualified individual with a physical or mental impairment that limits a major life activity.
Signature of applicant / Date
Signature of staff person accepting this application / Date
VOLUNTARY SELF-IDENTIFICATION
(CONFIDENTIAL - FOR STATISTICAL USE ONLY)
This page is completely voluntary and you do not have to fill it out. Your job application will not be favored or disfavored because you did or did not complete this page.
The Fayetteville Public Library is an equal opportunity employer and does not discriminate on the basis of race, color, religion, sex, age, national origin, disability, veteran status, or any other classification protected by federal, state or local law.
Due to the Library’s receipt of Federal Grant Money, it is required to ask you to voluntarily provide the information below. If you choose to provide it, the information will be recorded for Equal Employment Opportunity Program purposes. This form will be removed from the job application by Human Resource staff for the purpose of recording the information for statistical analysis.
The rest of your application will then be forwarded to the hiring supervisor(s) for consideration. Neither the hiring supervisor nor any hiring decision makers will see this form.
Referral source (please check one):
__Advertisement __Internal Job Posting __Friend __Relative
__Walk-in __Employment agency ___ Recruiting ____ Job Fair __Other
Gender: ___ Female ___ Male
___ White (Not Hispanic or Latino) – A person having origins in any of the original peoples of Europe, the Middle East, or North Africa.
___ Black or African American (Not Hispanic or Latino) – A person having origins in any of the black racial groups of Africa.
___ Hispanic or Latino – A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race.
___ Asian or Pacific Islander (Not Hispanic or Latino) – A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian Subcontinent or the Pacific Islands. This area includes, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, Samoa, and Vietnam.
___ American Indian or Alaska Native (Not Hispanic or Latino) – A person having origins in any of the original peoples of North America, and who maintain cultural identification through tribal affiliation or community recognition.
NOTE: If you are a veteran, and an offer of employment is made to you, after the offer has been made and you have accepted, please notify the Human Resources Division of your veteran status at your New Employee Meeting when you are placed on payroll. This is strictly for EEOP program purposes. Thank you.